超声引导下胸横肌阻滞对经剑突下纵隔肿瘤切除术患者围术期镇痛的影响

Effect of ultrasound-guided transverse thoracic muscle block on perioperative analgesia in patients undergoing resection of tumor in the inferior xiphoid mediastinum

目的观察超声引导下胸横肌阻滞对经剑突下纵隔肿瘤切除术患者围术期镇痛的影响。方法选取择期行剑突下纵隔肿瘤切除术患者26例作为研究对象,采用随机数字表法分为对照组(18例)和神经阻滞组(8例)。两组患者均行全身诱导麻醉,神经阻滞组患者于诱导后行双侧胸横肌阻滞,对照组采用全凭静脉麻醉维持。观察两组患者术后2h、术后24h和术后48h的静态和动态视觉模拟评分(VAS评分)。记录两组患者围术期阿片类药物的用量及术后拔管时间、补救镇痛率、镇痛泵按压次数及术后恶心呕吐发生率等指标。结果神经阻滞组患者术后2h、术后24h静态和动态VAS评分均小于对照组,差异均有统计学意义(P<0.05);神经阻滞组患者术毕拔管时间短于对照组,差异有统计学意义(P<0.05);神经阻滞组患者术中瑞芬太尼用量少于对照组,差异有统计学意义(P<0.05);神经阻滞组患者术后补救镇痛率明显低于对照组,差异有统计学意义(P<0.05)。结论胸横肌阻滞可以减少经剑突下纵隔肿瘤切除术中阿片类药物的用量,并且可以提供满意的术后镇痛效果。

Objective To observe the effect of ultrasound-guided transverse pectoralis block on perioperative analgesia in patients undergoing resection of tumor in the inferior xiphoid mediastinum.Methods A total of 26 patients with tumor resection of the inferior xiphoid mediastinum were randomly divided into control group(18 cases)and nerve block group(8 cases).Both groups received general induction anesthesia,the nerve block group received bilateral transverse pectoralis block after induction,and the control group was maintained with total intravenous anesthesia.The static and dynamic visual analogue scale(VAS)scores at the 2 hours after operation,24 hours after operation and 48 hours after operation were observed.The dosage of opioid drugs in the two groups during the perioperative period,the time of pulling out the tube,the rate of recovery analgesia,the times of pressure of the analgesia pump and the incidence of nausea and vomiting were recorded.Results The static and dynamic VAS scores of 2 hours after operation and 24 hours after operation in the nerve block group were lower than those in the control group,and the differences were statistically significant(P<0.05).The extubation time of the nerve block group was shorter than that of the control group,and the difference was statistically significant(P<0.05).The dosage of remifentanil in the nerve block group was less than that in the control group,and the difference was statistically significant(P<0.05).The rescue analgesia rate of the nerve block group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Thoracic transverse muscle block can reduce the dosage of opioids in resection of tumor in the inferior xiphoid mediastinum,and can provide satisfactory postoperative analgesic effect.